Repeat Infective Endocarditis in Persons Who Inject Drugs: Demographic and Clinical Characteristics (n = 22)
| Characteristic . | Result . |
|---|---|
| Male, No. (%) | 11 (50) |
| Caucasian, No. (%) | 22 (100) |
| Age, median (IQR), y | 28.5 (22–38) |
| Nonmetro residence, No. (%) | 15 (68.2) |
| Days since completion of prior antimicrobial therapy for previous episode of IE, median (IQR) | 109 (72–151) |
| Referred to substance counseling during first admission, No. (%) | 13 (59.1) |
| Time since last use of intravenous drugs before admission, No. (%) | |
| <1 wk | 13 (59.1) |
| 1–4 wk | 5 (22.3) |
| Unclear timing of last use | 4 (18.2) |
| Preferred drug for injection, No. (%) | |
| Prescription opioids | 15 (68.2) |
| Heroin | 7 (31.8) |
| Cocaine | 2 (9.1) |
| Methamphetamines | 5 (22.3) |
| Comorbidities, No. (%) | |
| Hepatitis C virus infection | 18 (81.2) |
| Old/resolved (antibody-positive, RNA-negative) | 4 (18.2) |
| Active (antibody- and RNA-positive) | 8 (36.4) |
| Unknown (viral RNA not checked) | 6 (27.3) |
| Negative | 4 (18.2) |
| HIV infection | 0 |
| Charlson Comorbidity Index, median (IQR) | 0 (0–0.8) |
| Duration of symptoms before presentation, No. (%) | |
| <1 wk | 12 (54.5) |
| 1–2 wk | 5 (22.7) |
| Duration unknown | 5 (22.7) |
| Symptoms before presentation, No. (%) | |
| Subjective fevers | 8 (36.4) |
| Chills | 6 (27.3) |
| Chest pain | 8 (36.4) |
| Shortness of breath | 4 (18.2) |
| Musculoskeletal pain | 8 (36.4) |
| Neurologic symptomsa | 3 (13.4) |
| Severity of illness at time of admission for repeat episode, median (IQR) | |
| Pitt bacteremia score | 3.0 (0–2) |
| Apache II score | 12.0 (8–23) |
| Admission WBC, 10*3/uL | 14.4 (6.8–23) |
| Admission serum creatinine, mg/dL | 1.70 (1.1–2.0) |
| Time to defervescence of fever,b d | 3 (1–7) |
| Time to clearance of bacteremia,b d | 3 (1–5) |
| Echocardiographic findings, No. (%) | |
| Patients undergoing TTE/No. with demonstrated vegetations | 22 (100)/19 (86.4) |
| Patients undergoing TEE/No. with demonstrated vegetations | 14 (63.6)/13 (59.1) |
| Site of vegetations, No. (%) | |
| Tricuspid valve | 17 (77.3) |
| Mitral valve | 5 (22.7) |
| Aortic valve | 3 (13.4) |
| Pulmonic valve | 1 (4.5) |
| Multiple valves | 3 (13.4) |
| Vegetation on same valve as prior episode | 19 (86.4) |
| Type of valve involved, No. (%) | |
| Native | 15 (68.2) |
| Prosthetic | 7 (31.8) |
| Microbiology of rIE, No. (%) | |
| Staphylococcus aureus | 12 (54.5) |
| Streptococci | 5 (22.3) |
| Enterococcus | 3 (13.6) |
| Fungal | 3 (13.6) |
| Polymicrobial | 4 (18.2) |
| Classification of rIEb, No. (%) | |
| Relapse | 3 (13.6) |
| Re-infection | 19 (86.4) |
| Complications associated with rIE, No. (%) | 13 (59.1) |
| Septic arthritis/osteomyelitis | 2 (9.1) |
| Septic pulmonary emboli +/- pneumonia +/- empyema | 10 (45.5) |
| CNS emboli | 4 (18.2) |
| Splenic emboli +/- abscess | 0 |
| Requirement for hemodialysis, No. (%) | 2 (9.1) |
| Management in ICU, No. (%) | 18 (81.2) |
| Length of ICU stay, median (IQR), d | 4 (2–9) |
| Invasive cardiac interventions, No. (%) | 5 (22.7) |
| Valve repair | 1 (4.5) |
| Valve replacement | 1 (4.5) |
| Annuloplasty | 3 (13.4) |
| Percutaneous vegectomy | 0 |
| Length of hospitalization for rIE, median (IQR), d | 16 (8–46) |
| Duration of antimicrobial therapy for rIE, median (IQR), d | 16 (7–43) |
| Left AMA before completing antimicrobial course, No. (%) | 2 (9.1) |
| Costs of hospitalization for management of rIE, median (IQR), $ | 90 675 (39 167–134 624) |
| Outcomes, No. (%) | |
| Death during hospitalization for rIE | 7 (31.8) |
| 1-y mortality | 8 (36.4) |
| Another episode of rIE in subsequent 12 mo | 4 (18.2) |
| Characteristic . | Result . |
|---|---|
| Male, No. (%) | 11 (50) |
| Caucasian, No. (%) | 22 (100) |
| Age, median (IQR), y | 28.5 (22–38) |
| Nonmetro residence, No. (%) | 15 (68.2) |
| Days since completion of prior antimicrobial therapy for previous episode of IE, median (IQR) | 109 (72–151) |
| Referred to substance counseling during first admission, No. (%) | 13 (59.1) |
| Time since last use of intravenous drugs before admission, No. (%) | |
| <1 wk | 13 (59.1) |
| 1–4 wk | 5 (22.3) |
| Unclear timing of last use | 4 (18.2) |
| Preferred drug for injection, No. (%) | |
| Prescription opioids | 15 (68.2) |
| Heroin | 7 (31.8) |
| Cocaine | 2 (9.1) |
| Methamphetamines | 5 (22.3) |
| Comorbidities, No. (%) | |
| Hepatitis C virus infection | 18 (81.2) |
| Old/resolved (antibody-positive, RNA-negative) | 4 (18.2) |
| Active (antibody- and RNA-positive) | 8 (36.4) |
| Unknown (viral RNA not checked) | 6 (27.3) |
| Negative | 4 (18.2) |
| HIV infection | 0 |
| Charlson Comorbidity Index, median (IQR) | 0 (0–0.8) |
| Duration of symptoms before presentation, No. (%) | |
| <1 wk | 12 (54.5) |
| 1–2 wk | 5 (22.7) |
| Duration unknown | 5 (22.7) |
| Symptoms before presentation, No. (%) | |
| Subjective fevers | 8 (36.4) |
| Chills | 6 (27.3) |
| Chest pain | 8 (36.4) |
| Shortness of breath | 4 (18.2) |
| Musculoskeletal pain | 8 (36.4) |
| Neurologic symptomsa | 3 (13.4) |
| Severity of illness at time of admission for repeat episode, median (IQR) | |
| Pitt bacteremia score | 3.0 (0–2) |
| Apache II score | 12.0 (8–23) |
| Admission WBC, 10*3/uL | 14.4 (6.8–23) |
| Admission serum creatinine, mg/dL | 1.70 (1.1–2.0) |
| Time to defervescence of fever,b d | 3 (1–7) |
| Time to clearance of bacteremia,b d | 3 (1–5) |
| Echocardiographic findings, No. (%) | |
| Patients undergoing TTE/No. with demonstrated vegetations | 22 (100)/19 (86.4) |
| Patients undergoing TEE/No. with demonstrated vegetations | 14 (63.6)/13 (59.1) |
| Site of vegetations, No. (%) | |
| Tricuspid valve | 17 (77.3) |
| Mitral valve | 5 (22.7) |
| Aortic valve | 3 (13.4) |
| Pulmonic valve | 1 (4.5) |
| Multiple valves | 3 (13.4) |
| Vegetation on same valve as prior episode | 19 (86.4) |
| Type of valve involved, No. (%) | |
| Native | 15 (68.2) |
| Prosthetic | 7 (31.8) |
| Microbiology of rIE, No. (%) | |
| Staphylococcus aureus | 12 (54.5) |
| Streptococci | 5 (22.3) |
| Enterococcus | 3 (13.6) |
| Fungal | 3 (13.6) |
| Polymicrobial | 4 (18.2) |
| Classification of rIEb, No. (%) | |
| Relapse | 3 (13.6) |
| Re-infection | 19 (86.4) |
| Complications associated with rIE, No. (%) | 13 (59.1) |
| Septic arthritis/osteomyelitis | 2 (9.1) |
| Septic pulmonary emboli +/- pneumonia +/- empyema | 10 (45.5) |
| CNS emboli | 4 (18.2) |
| Splenic emboli +/- abscess | 0 |
| Requirement for hemodialysis, No. (%) | 2 (9.1) |
| Management in ICU, No. (%) | 18 (81.2) |
| Length of ICU stay, median (IQR), d | 4 (2–9) |
| Invasive cardiac interventions, No. (%) | 5 (22.7) |
| Valve repair | 1 (4.5) |
| Valve replacement | 1 (4.5) |
| Annuloplasty | 3 (13.4) |
| Percutaneous vegectomy | 0 |
| Length of hospitalization for rIE, median (IQR), d | 16 (8–46) |
| Duration of antimicrobial therapy for rIE, median (IQR), d | 16 (7–43) |
| Left AMA before completing antimicrobial course, No. (%) | 2 (9.1) |
| Costs of hospitalization for management of rIE, median (IQR), $ | 90 675 (39 167–134 624) |
| Outcomes, No. (%) | |
| Death during hospitalization for rIE | 7 (31.8) |
| 1-y mortality | 8 (36.4) |
| Another episode of rIE in subsequent 12 mo | 4 (18.2) |
Abbreviations: AMA, against medical advice; CNS, central nervous system; ICU, intensive care unit; IE, infective endocarditis; IQR, interquartile range; rIE, repeat infective endocarditis; TEE, transesophageal echocardiogram; TTE, transthoracic echocardiogram; WBC, white blood cell count.
aNeurological symptoms included stroke, transient ischemic attack, numbness, tingling, visual changes, speech impairment.
bRefer to the “Methods” for a definition.
Repeat Infective Endocarditis in Persons Who Inject Drugs: Demographic and Clinical Characteristics (n = 22)
| Characteristic . | Result . |
|---|---|
| Male, No. (%) | 11 (50) |
| Caucasian, No. (%) | 22 (100) |
| Age, median (IQR), y | 28.5 (22–38) |
| Nonmetro residence, No. (%) | 15 (68.2) |
| Days since completion of prior antimicrobial therapy for previous episode of IE, median (IQR) | 109 (72–151) |
| Referred to substance counseling during first admission, No. (%) | 13 (59.1) |
| Time since last use of intravenous drugs before admission, No. (%) | |
| <1 wk | 13 (59.1) |
| 1–4 wk | 5 (22.3) |
| Unclear timing of last use | 4 (18.2) |
| Preferred drug for injection, No. (%) | |
| Prescription opioids | 15 (68.2) |
| Heroin | 7 (31.8) |
| Cocaine | 2 (9.1) |
| Methamphetamines | 5 (22.3) |
| Comorbidities, No. (%) | |
| Hepatitis C virus infection | 18 (81.2) |
| Old/resolved (antibody-positive, RNA-negative) | 4 (18.2) |
| Active (antibody- and RNA-positive) | 8 (36.4) |
| Unknown (viral RNA not checked) | 6 (27.3) |
| Negative | 4 (18.2) |
| HIV infection | 0 |
| Charlson Comorbidity Index, median (IQR) | 0 (0–0.8) |
| Duration of symptoms before presentation, No. (%) | |
| <1 wk | 12 (54.5) |
| 1–2 wk | 5 (22.7) |
| Duration unknown | 5 (22.7) |
| Symptoms before presentation, No. (%) | |
| Subjective fevers | 8 (36.4) |
| Chills | 6 (27.3) |
| Chest pain | 8 (36.4) |
| Shortness of breath | 4 (18.2) |
| Musculoskeletal pain | 8 (36.4) |
| Neurologic symptomsa | 3 (13.4) |
| Severity of illness at time of admission for repeat episode, median (IQR) | |
| Pitt bacteremia score | 3.0 (0–2) |
| Apache II score | 12.0 (8–23) |
| Admission WBC, 10*3/uL | 14.4 (6.8–23) |
| Admission serum creatinine, mg/dL | 1.70 (1.1–2.0) |
| Time to defervescence of fever,b d | 3 (1–7) |
| Time to clearance of bacteremia,b d | 3 (1–5) |
| Echocardiographic findings, No. (%) | |
| Patients undergoing TTE/No. with demonstrated vegetations | 22 (100)/19 (86.4) |
| Patients undergoing TEE/No. with demonstrated vegetations | 14 (63.6)/13 (59.1) |
| Site of vegetations, No. (%) | |
| Tricuspid valve | 17 (77.3) |
| Mitral valve | 5 (22.7) |
| Aortic valve | 3 (13.4) |
| Pulmonic valve | 1 (4.5) |
| Multiple valves | 3 (13.4) |
| Vegetation on same valve as prior episode | 19 (86.4) |
| Type of valve involved, No. (%) | |
| Native | 15 (68.2) |
| Prosthetic | 7 (31.8) |
| Microbiology of rIE, No. (%) | |
| Staphylococcus aureus | 12 (54.5) |
| Streptococci | 5 (22.3) |
| Enterococcus | 3 (13.6) |
| Fungal | 3 (13.6) |
| Polymicrobial | 4 (18.2) |
| Classification of rIEb, No. (%) | |
| Relapse | 3 (13.6) |
| Re-infection | 19 (86.4) |
| Complications associated with rIE, No. (%) | 13 (59.1) |
| Septic arthritis/osteomyelitis | 2 (9.1) |
| Septic pulmonary emboli +/- pneumonia +/- empyema | 10 (45.5) |
| CNS emboli | 4 (18.2) |
| Splenic emboli +/- abscess | 0 |
| Requirement for hemodialysis, No. (%) | 2 (9.1) |
| Management in ICU, No. (%) | 18 (81.2) |
| Length of ICU stay, median (IQR), d | 4 (2–9) |
| Invasive cardiac interventions, No. (%) | 5 (22.7) |
| Valve repair | 1 (4.5) |
| Valve replacement | 1 (4.5) |
| Annuloplasty | 3 (13.4) |
| Percutaneous vegectomy | 0 |
| Length of hospitalization for rIE, median (IQR), d | 16 (8–46) |
| Duration of antimicrobial therapy for rIE, median (IQR), d | 16 (7–43) |
| Left AMA before completing antimicrobial course, No. (%) | 2 (9.1) |
| Costs of hospitalization for management of rIE, median (IQR), $ | 90 675 (39 167–134 624) |
| Outcomes, No. (%) | |
| Death during hospitalization for rIE | 7 (31.8) |
| 1-y mortality | 8 (36.4) |
| Another episode of rIE in subsequent 12 mo | 4 (18.2) |
| Characteristic . | Result . |
|---|---|
| Male, No. (%) | 11 (50) |
| Caucasian, No. (%) | 22 (100) |
| Age, median (IQR), y | 28.5 (22–38) |
| Nonmetro residence, No. (%) | 15 (68.2) |
| Days since completion of prior antimicrobial therapy for previous episode of IE, median (IQR) | 109 (72–151) |
| Referred to substance counseling during first admission, No. (%) | 13 (59.1) |
| Time since last use of intravenous drugs before admission, No. (%) | |
| <1 wk | 13 (59.1) |
| 1–4 wk | 5 (22.3) |
| Unclear timing of last use | 4 (18.2) |
| Preferred drug for injection, No. (%) | |
| Prescription opioids | 15 (68.2) |
| Heroin | 7 (31.8) |
| Cocaine | 2 (9.1) |
| Methamphetamines | 5 (22.3) |
| Comorbidities, No. (%) | |
| Hepatitis C virus infection | 18 (81.2) |
| Old/resolved (antibody-positive, RNA-negative) | 4 (18.2) |
| Active (antibody- and RNA-positive) | 8 (36.4) |
| Unknown (viral RNA not checked) | 6 (27.3) |
| Negative | 4 (18.2) |
| HIV infection | 0 |
| Charlson Comorbidity Index, median (IQR) | 0 (0–0.8) |
| Duration of symptoms before presentation, No. (%) | |
| <1 wk | 12 (54.5) |
| 1–2 wk | 5 (22.7) |
| Duration unknown | 5 (22.7) |
| Symptoms before presentation, No. (%) | |
| Subjective fevers | 8 (36.4) |
| Chills | 6 (27.3) |
| Chest pain | 8 (36.4) |
| Shortness of breath | 4 (18.2) |
| Musculoskeletal pain | 8 (36.4) |
| Neurologic symptomsa | 3 (13.4) |
| Severity of illness at time of admission for repeat episode, median (IQR) | |
| Pitt bacteremia score | 3.0 (0–2) |
| Apache II score | 12.0 (8–23) |
| Admission WBC, 10*3/uL | 14.4 (6.8–23) |
| Admission serum creatinine, mg/dL | 1.70 (1.1–2.0) |
| Time to defervescence of fever,b d | 3 (1–7) |
| Time to clearance of bacteremia,b d | 3 (1–5) |
| Echocardiographic findings, No. (%) | |
| Patients undergoing TTE/No. with demonstrated vegetations | 22 (100)/19 (86.4) |
| Patients undergoing TEE/No. with demonstrated vegetations | 14 (63.6)/13 (59.1) |
| Site of vegetations, No. (%) | |
| Tricuspid valve | 17 (77.3) |
| Mitral valve | 5 (22.7) |
| Aortic valve | 3 (13.4) |
| Pulmonic valve | 1 (4.5) |
| Multiple valves | 3 (13.4) |
| Vegetation on same valve as prior episode | 19 (86.4) |
| Type of valve involved, No. (%) | |
| Native | 15 (68.2) |
| Prosthetic | 7 (31.8) |
| Microbiology of rIE, No. (%) | |
| Staphylococcus aureus | 12 (54.5) |
| Streptococci | 5 (22.3) |
| Enterococcus | 3 (13.6) |
| Fungal | 3 (13.6) |
| Polymicrobial | 4 (18.2) |
| Classification of rIEb, No. (%) | |
| Relapse | 3 (13.6) |
| Re-infection | 19 (86.4) |
| Complications associated with rIE, No. (%) | 13 (59.1) |
| Septic arthritis/osteomyelitis | 2 (9.1) |
| Septic pulmonary emboli +/- pneumonia +/- empyema | 10 (45.5) |
| CNS emboli | 4 (18.2) |
| Splenic emboli +/- abscess | 0 |
| Requirement for hemodialysis, No. (%) | 2 (9.1) |
| Management in ICU, No. (%) | 18 (81.2) |
| Length of ICU stay, median (IQR), d | 4 (2–9) |
| Invasive cardiac interventions, No. (%) | 5 (22.7) |
| Valve repair | 1 (4.5) |
| Valve replacement | 1 (4.5) |
| Annuloplasty | 3 (13.4) |
| Percutaneous vegectomy | 0 |
| Length of hospitalization for rIE, median (IQR), d | 16 (8–46) |
| Duration of antimicrobial therapy for rIE, median (IQR), d | 16 (7–43) |
| Left AMA before completing antimicrobial course, No. (%) | 2 (9.1) |
| Costs of hospitalization for management of rIE, median (IQR), $ | 90 675 (39 167–134 624) |
| Outcomes, No. (%) | |
| Death during hospitalization for rIE | 7 (31.8) |
| 1-y mortality | 8 (36.4) |
| Another episode of rIE in subsequent 12 mo | 4 (18.2) |
Abbreviations: AMA, against medical advice; CNS, central nervous system; ICU, intensive care unit; IE, infective endocarditis; IQR, interquartile range; rIE, repeat infective endocarditis; TEE, transesophageal echocardiogram; TTE, transthoracic echocardiogram; WBC, white blood cell count.
aNeurological symptoms included stroke, transient ischemic attack, numbness, tingling, visual changes, speech impairment.
bRefer to the “Methods” for a definition.
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